Cardiac tamponade related to a coronary injury by a pericardial calcification: an unusual complication

<p>Abstract</p> <p>Background</p> <p>Cardiac tamponade is a rare but severe complication of pericardial effusion with a poor prognosis. Prompt diagnosis using transthoracic echocardiography allows guiding initial therapeutic management. Although etiologies are numerous, cardiac tamponade is more often due to a hemopericardium. Rarely, a coronary injury may result in such a hemopericardium with cardiac tamponade. Coronary artery aneurysm are the main etiologies but blunt, open chest trauma or complication of endovascular procedures have also been described.</p> <p>Case presentation</p> <p>A 83-year-old hypertensive man presented for dizziness and hypotension. The patient had oliguria and mottled skin. Transthoracic echocardiography disclosed a circumferential pericardial effusion with a compressed right atrium, confirmed by contrast-enhanced thoracic CT scan. A pig-tail catheter allowed to withdraw 500 mL of blood, resulting in a transient improvement of hemodynamics. Rapidly, recurrent hypotension prompted a reoperation. An active bleeding was identified at the level of the retroventricular coronary artery. The pericardium was thickened with several "sharping" calcified plaques in the vicinity of the bleeding areas. On day 2, vasopressors were stopped and the patient was successfully extubated. Final diagnosis was a spontaneous cardiac tamponade secondary to a coronary artery injury attributed to a "sharping"calcified pericardial plaque.</p> <p>Conclusion</p> <p>Cardiac tamponade secondary to the development of a hemopericardium may develop as the result of a myocardial and coronary artery injury induced by a calcified pericardial plaque.</p

Résultats de la chirugie conventionnelle des anévrysmes de l'aorte abdominale sous-rénale (à propos de 208 cas)

Introduction : le choix entre chirurgie conventionnelle et endovasculaire est difficile car les résultats de ces deux techniques sont mal connus. L'objectif de ce travail est de définir les résultats précoces et tardifs de la chirurgie conventionnelle. Matériel et méthode : étude monocentrique rétrospective sur les anévrysmes de l'aorte abdominale sous rénale opérés au CHU de Limoges entre 1995 et 2000. Enquête réalisée en 2008. Résultats : 208 patients inclus. Suivis moyen : 7,3 années Mortalité péri-opératoire : 4,1% dans le groupe électif, 31,7% dans le groupe urgence. Au moment de l'enquête : 46% de survivants. Pas de différence en terme de survie tardive entre le groupe électif et urgence. 8,9% des patients ont bénéficiés d'une réintervention tardive dont la moitié pour éventration. Discussion : les résultats du CHU de Limoges sont comparables avec ceux des autres centres. La chirurgie conventionnelle nécessite moins de réinterventions que la chirurgie endovasculaire. Conclusion : la chirurgie conventionnelle est une technique sûre dont les résultats se maintiennent dans le temps.LIMOGES-BU Médecine pharmacie (870852108) / SudocSudocFranceF

Chirurgie des sténoses carotidiennes symptomatiques (résultats à Limoges)

LIMOGES-BU Médecine pharmacie (870852108) / SudocSudocFranceF

Artériopathie des membres inférieurs : le traitement

International audienceMedical management of peripheral arterial disease (PAD) patients is aimed at limb symptom relief and reducing systemic major adverse events risk. For the first purpose: exercise therapy is recommended in case of claudication; multidisciplinary evaluation for surgical options is mandatory in case of critical limb ischaemia. Reducing cardiac and stroke risk can be achieved through: statin prescription in most of the cases; antiplatelet agents in symptomatic PAD patients; cardio-vascular risk factors control

Preoperative hepatic insufficiency and type III endoleak: a confirmed potential fatal association following endovascular treatment.

International audienceConsumptive coagulopathy is known to occur in patients with aneurysm, especially in the thoracic localization. Compared to open chest surgery, the endovascular treatment leaves in place a large thrombosed aneurysmal sac, which might induce and/or exacerbate the coagulopathy. Although exceptional, some recent reports have raised the potential disastrous issue related to this complication. We report the case of a 74-year-old patient treated for an asymptomatic thoracic aorta aneurysm by endoprosthesis who developed a fatal disseminated intravascular coagulopathy. This complication has been related to a type III endoleak associated with a preoperative hepatic insufficiency

Assessment of Thoracic Endovascular Aortic Repair Using Relay Proximal Scallop: Results of a French Prospective Multicentre Study

International audienceOBJECTIVE: A proximal scallop design allows aortic arch repair without complex endovascular manipulation in the aortic arch. The aim was to assess the safety and efficacy at one year of the Relay proximal scallop stent graft. METHODS: A prospective multicentre study evaluated consecutive patients treated with the Relay proximal scallop stent graft in 10 French aortic centres. All consecutive patients eligible for elective thoracic endovascular repair with proximal scallop in the 10 participating centres between January 2015 and July 2018 were included. Primary endpoints were 30 day mortality, stroke, and spinal cord ischaemia (SCI) rates. Outcomes including safety and efficacy, technical and clinical success, all cause mortality, neurological events, vessel patency, and device specific complications were analysed. Survival and survival without severe complications were estimated using Kaplan-Meier estimates. RESULTS: Ten aortic centres treated 40 patients for thoracic aortic aneurysm (45%), penetrating atherosclerotic aneurysm (30%), and dissection (25%). Half of the procedures (50%) targeted zone 0 of the aortic arch (zone 0 in 17.5% and zones 0/1 in 32.5%), 37.5% targeted zone 2 (35% zone 2 alone; 2.5% zones 1/2), and 15% targeted zone 1 (12.5% zone 1 alone). Median follow up was one year. Thirty day mortality, stroke, and SCI rates were 10%, 5%, and 0% respectively. Primary technical success was 95%. Type Ia, Ib, and III endoleaks rates were 5.4%, 0%, and 0% respectively at one month. Overall mortality rate at one year was 17.5%. Aneurysm expansion was &gt; 5 mm in one case at one year associated with type Ia endoleak (3%). There was no supra-aortic trunk thrombosis, one (2%) graft kink, and no migration. CONCLUSION: One year outcomes showed that the Relay proximal scallop stent graft is an acceptable answer to aortic thoracic disease to deal with short proximal landing zones